Pathways to Independence: Transitioning Adults Under Age 65 from Nursing Homes to Community Living

Pathways to Independence: Transitioning Adults Under Age 65 from Nursing Homes to Community Living

The National Evaluation of the MFP Demonstration
Published: Dec 12, 2016
Publisher: Cambridge, MA: Mathematica Policy Research
Associated Project

Research and Evaluation of the Money Follows the Person (MFP) Demonstration Grants

Time frame: 2007-2017

Prepared for:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services


Carol V. Irvin

Claire Postman

Key Findings

Key Findings:

  • Though MFP demonstrations have no age-based procedures and processes, the six MFP grantees this study highlights offer several reasons why nursing home residents under age 65 appear to transition to the community at a higher rate than older residents.
  • Adults under age 65 frequently rely on peer networks and informal supports to help them transition. Four out of the six grantee states formally offer peer support services to MFP participants.
  • Under-65 adult nursing home residents tend to move to apartments in the community and benefit from the various initiatives MFP grantees have pursued to increase access to affordable and accessible housing.
  • All study states improved the integration of mental health services with other community-based long-term services and supports providers, which has benefitted under-65 adult participants.

The Money Follows the Person (MFP) demonstration supports states’ efforts to help Medicaid beneficiaries living in long-term care facilities transition back to the community. The data suggest that nursing home residents under age 65 have disproportionately benefited from the MFP demonstration. This report examines why this group has transitioned to the community at a higher rate than older nursing home residents and what strategies six MFP grantees are using to transition the working-age adult population from nursing homes to the community. 

Our assessment of six leading MFP grantees suggests that MFP demonstrations do not purposefully target this population. Outreach and other procedures, processes, and services for transitioning nursing home residents are not based on age, but are available to everyone in nursing home care. The only identifiable factors that differ are the perceptions of nursing home discharge planners regarding which nursing home residents are good candidates for transition and the characteristics of this subgroup.

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